It discusses investigations useful in diagnosis of inflammatory bowel disease and their important findings e.g Barium enema, histopathology, a word about indeterminate colitis and followed by discussion of possible etiologies to be ruled out before diagnosing IBD
It discusses investigations useful in diagnosis of inflammatory bowel disease and their important findings e.g Barium enema, histopathology, a word about indeterminate colitis and followed by discussion of possible etiologies to be ruled out before diagnosing IBD
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
Tracheo oesophageal atresia and fistula A-Z for medical students
This powerpoint covers everything you need to know about tracheoesophageal fistula and atresia as a medical student.It is not intended for patients. Covers anatomy, embryology,types ,classification and treatment of tracheo-oesophageal fistula and atresia.
Esophagoscopy continues to be a reliable diagnostic and therapeutic tool with a wide variety of applications, including biopsy, dilatation of strictures, repair of Zenker's diverticulum, placement of stents, and retrieval of foreign bodies.
Similar to mid & lower esophageal diverticulum.pptx (20)
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Surgical Management of Mid- &
Distal Esophageal Diverticula
Dr ROHAN NU
MCh Resident
Institute of SGE & LTx
5.5.2022
2. Introduction
• Defined as focal outpouching of one or more layers of esophageal wall
• Described by their location : pharyngoesophageal, mid-esophagus & epiphrenic
• Usually false diverticulum; true variety occurs in mid-esophagus & is rare
• Often asymptomatic; common among elderly with multiple comorbidities, careful surgical planning
necessary
4. Introduction
A pulsion diverticulum most often found in the distal 10 cm of the esophagus, usually false variety
(outpouching of mucosa & submucosa only); m/c on RIGHT side
almost always secondary to an underlying esophageal motility disorder (achalasia > DES)
Other proposed causes – distal stricture, prior fundoplication, hiatus hernia
Dysmotility uncoordinated contraction between the distal esophagus and LES increased
intraluminal pressure subsequent herniation through a weakened area of the esophagus
5. Diagnosis
Usually asymptomatic; dysphagia m/c symptom
(90%), followed by regurgitation; repeated aspiration
in 30%
Initial study is BS; HRM & OGD also in evaluation
before surgical planning
CT scan of the chest for determining the true
proximal extent of the diverticulum.
Decision to offer Rx based on presence & SEVERITY of
symptoms
6. BARIUM SWALLOW OGD HRM
Allows measurement of length
and size of diverticulum
Orients diverticulum (right/left)
Identifies other pathology such
as hiatal hernia, stricture
Provides information about
esophageal motility
Defines anatomy of
diverticulum, including precise
location relative to GEJ
Assesses for concomitant
pathology such as ulceration
malignancy
Used to treat bleeding, place
manometry catheter, feeding
tube
Defines underlying motility
disorder
May need to be placed
endoscopically or under
fluoroscopy
Potentially guides length of
myotomy
7. Sx
The decision to offer treatment is based on the patient’s symptoms & SEVERITY of those
symptoms
Asymptomatic patients can be managed conservatively; continued follow-up is necessary
because of the development of worsening symptoms
Surgical principles
• Delineation of the entire diverticulum at the mucosal level
• Definition of the “neck” of the diverticulum
• Resection of the diverticulum
• Closure of the overlying muscle with or without buttress
• Distal myotomy with or without partial fundoplication
8. Approaches
Open Transthoracic
Video-assisted thoracic surgery (VATS)
Laparoscopic
combined VATS + Lap
endoscopic approach
Choice of approach depends mainly on location & size of diverticulum
Assess the location of the diverticulum based on the location of the upper border of the
diverticulum in relation to endoscopically identified GEJ.
9. Diverticula <5 cm above the GEJ, a lap transhiatal approach
Diverticula >5 cm above the GEJ or above the inferior pulmonary vein, a combined thoracoscopic-
laparoscopic minimally invasive approach
Reasons for need for an esophagomyotomy
Most diverticula are associated with an underlying motility disorder & a distal obstruction or high
pressure zone increases the risk for staple line dehiscence and subsequent leak
myotomy creates the potential for GERD, which requires a fundoplication and/or the need for PPI
10. TRANSTHORACIC APPROACH
7th or 8th ICS LEFT thoracotomy
Entire distal esophagus mobilized including hiatus
overlying muscle is split along the length of the diverticulum taking care to avoid the vagus nerve
muscle dissected away to expose the superior & inferior margins of the diverticulum
Define the “neck” / “waist”, till the mucosal level
Intra-op endoscopy can be used
11. Stapler division of diverticulum; adjacent muscle edges approximated with pleura
Buttress of pleura / intercostal muscle can also be added
The esophagogastric myotomy on contralateral side, at the location of the inferior aspect of
diverticulectomy
Distally extended onto the stomach for 2 cm; proximal extent depends on surgeon
+/- partial fundoplication
12.
13. VATS ± LAP MYOTOMY /
FUNDOPLICATION
placement of double-lumen endotracheal tube,
patient placed in the left lateral decubitus position
4 ports
1. seventh intercostal space [ICS] posterior axillary line
for surgeon’s left hand, stapler
2. ninth ICS in the line of the scapular tip for the
camera
3. fourth ICS posterior axillary line for retraction and
suctioning
4. seventh ICS just inferior & posterior to the scapular
tip for the surgeon’s right hand
4th ICS
Assistant
port
7th ICS
9th ICS - Camera
7th ICS
14. VATS only approach difficult to perform distal myotomy; access to proximal stomach limited
So lap approach used for completion of myotomy with/without a partial fundoplication
To ensure the proper extent of the myotomy, the distal end of the diverticulum is marked with a
clip on the anterior surface of the esophageal wall at the completion of the VATS portion
15. LAP TRANSHIATAL APPROACH
low lithotomy with placement of 5 ports.
Identification of both vagi, max mobilization till distal
extent of divertivculum & complete circumferential
dissection
Dissection at neck of diverticulum till mucosa
exposed
Stapler used over an endoscope / bougie & stapler
line reinforced
Myotomy performed along the left anterior wall of
the esophagus just to the left of midline
diverticula >5 cm from the GEJ will be inadequately
addressed; higher propensity for incomplete
resection or a staple line leak at the superior-most
aspect of the diverticulectomy
16.
17. ENDOSCOPIC APPROACH
At experimental stage; GE reflux is a potential complication
Khashab MA. Thoughts on starting a peroral endoscopic myotomy program. Gastrointest Endosc.
2013;77(1):109-110.
Liu B-R, Song J, Fan Q. 899 endoscopic esophageal epiphrenic diverticulum inversion by using the
submsubmucosal tunneling technique. Gastrointest Endosc. 2015;81(5):AB180.
submucosal tunnel created to facilitate a distal esophageal myotomy (as done during POEM for
achalasia)
diverticulum is inverted into the lumen & an endoscopic snare placed around the neck of the
diverticulum; mucosa eventually sloughs and the defect heals over time
A channel is created between the diverticulum and the gastric body by means of a
transdiverticulum-to-gastric puncture and subsequent dilation of the channel and placement of an
endoscopic stent
18. COMPLICATIONS
Surgery specific complications - staple line leak, incomplete myotomy, vagal nerve injury
(manifested by delayed gastric emptying), and pleural effusion
Staple line leaks are best avoided by careful and meticulous dissection, re-approximation of the
esophageal muscle, and complete myotomy
If occurs NPO, broad-spectrum antibiotics, alternate form of nutrition support; OGD very
important for early Mx
When feasible options are endoscopic stenting, clips, or suturing to control leakage
if not successful OPEN wide drainage, control of contamination & +/- diversion
22. Introduction
True diverticula; found in the middle one-third of the esophagus within 4 to 5 cm of the
tracheal carina
A traction diverticula that occur due to mediastinal inflammation pulling on the esophageal
wall to create the diverticulum in the middle third of the esophagus [Sarcoidosis, TB,
Histoplasmosis]
congenital component related to an incomplete trachealesophageal fistula or foregut
duplication
In addition to the traction etiology, there is most likely a pulsion component, as motility
disorders are present in over 80% of patients
23. Diagnosis
Typically asymptomatic, due to their wide-mouth
opening and dependent drainage; diagnosed
incidentally
Symptoms include intermittent dysphagia and some
with occasional retrosternal pain, heartburn, and/or acid
reflux
Ongoing inflammation erosion fistula between
airway & diverticulum bleeding 2* to erosion
bronchial artery branch
The initial test that identifies the diverticulum is a CT
scan of the chest during evaluation for mediastinal
adenopathy or for chronic cough
HRM in the absence of obvious chest pathology
Bronchoscopy along with OGD
24. Sx
Best approached with a right thoracotomy through 5th ICS (ease of access to the carina,
mediastinal nodes, and esophagus)
Extensive inflammation, extensive scarring & distorted anatomy expected
separate the esophagus and diverticulum from the adjoining mediastinal nodes
diverticulum should be isolated, and the mucosa should be evaluated and repaired or resected
depending on the degree of damage
overlying muscle layers should be re-approximated over top with an interposition graft usually
intercostal muscle – prevents recurrence
Distal myotomy for underlying motility disorder
A left posterolateral thoracotomy incision is shown in the inset.
Exposure of the diverticulum is obtained when the chest is entered through the bed of the eighth rib. Note that the esophagus has
been delivered from its mediastinal bed, tape has been passed around the esophagus, and the esophagus has been rotated to bring the
diverticulum into view.
The neck of the diverticulum has been dissected to identify the defect in the esophageal muscular wall (A).
A TA stapling device is used to transect and close the diverticulum followed by closure of the esophageal musculature over a mucosal suture
line (B).
The site of the diverticular incision has been rotated back to the right and is not visible.
A long esophagomyotomy extending from the esophagogastric junction to the aortic arch has been performed. The musculature of the esophagus has been freed from approximately 50% of the circumference of the esophageal mucosal tube to allow the mucosa to bulge through the muscular incision (C)
(A) Heller myotomy performed on the opposite esophageal wall of the stapled line and extending for approximately 2 cm on
the gastric side.
(B) A Dor fundoplication is constructed by suturing the anterior fundic wall to the edges of the myotomy.
cumulative experience to date suggests that a laparoscopic approach is quickly becoming the approach of choice with the addition of
VATS for diverticula placed higher in the mediastinum.